Chikungunya (CHIK) virus is a ribonucleic acid (RNA) virus with a single stranded, positive sequence RNA genome. It causes CHIK fever, a vector borne disease transmitted by mosquitoes belonging to the genus Aedes. The disease is characterized by abrupt onset of fever, chill, headache and severe joint pain. The incubation period of the virus ranges from one to12 days; the infection is always self-limiting and rarely fatal. CHIK virus originated from Africa and spread to Asia and other parts of the world. It has different genotypes and varied modes of transmission. The virus, with a history of emergence and re-emergence, is responsible for several epidemics and isolated outbreaks involving large populations in many parts of Africa and Asia as well as other regions of the world. The mystery behind the repeated re-emergence of CHIK virus is still unresolved. This is a major challenge for the medical fraternity.

Parapneumonic effusions and empyema are common clinical problems with varying prognosis and treatment options based upon the organism isolated. A total of 448 clinically suspected cases of empyema were analyzed by retrospective analysis. The male:female ratio was 1.87:1. Most common presenting symptoms were fever (90%), cough (80%), chest pain (60%), expectoration (60%), and dyspnea (60%). The most common underlying predisposing factor was chronic obstructive pulmonary disease (COPD) in 60% of cases. Culture was positive in 11.16% (50/448) of cases. Most common isolate was methicillin-resistant Staphylococcus aureus (MRSA) (24/70) followed by methicillin-sensitive Staphylococcus aureus (MSSA) (8/70), Klebsiella pneumoniae (8/70), Pseudomonas aeruginosa (8/70), and Acinetobacter species (7/70). Five patients from whom multi drug resistant Gram-negative bacilli were isolated expired.

Context: Childbirth practices. Aims: To evaluate the prevalence of various birth practices amongst obstetricians of Delhi. Materials and Methods: Obstetricians from various hospitals of Delhi were questioned about various birth practices that they followed and the results were analyzed. Results: There was infrequent use of beneficial practices that should be encouraged and an unexpectedly high level of harmful practices that should be eliminated. Some beneficial practices were applied inappropriately, and practices of unproved benefit were also documented, some of which are of potential harm to the mother and baby. Conclusion: Birth practices were not in accordance with the WHO guidelines. This points toward a lack of awareness of evidence-based medicine.

Context: Studies identified prevalence of vitamin A deficiency among Indian preschool-aged children. Aims: The meta-analysis was conducted on peer-reviewed articles published between 1960 and 2007. Settings and Design: Thirteen epidemiologic studies were identified from 250 potentially relevant articles. Material and methods: Studies were selected on, Firstly; a broad criterion of vitamin A deficiency among Indian preschool-aged children was developed on information provided in the WHO publication. Secondly, 'Night Blindness (XN)' among preschool-age children along with Corneal Xerosis associated with Bitot's spot (X1B) was considered as positive clinical signs. Finally, in absence of universally accepted criteria of reporting of prevalence, weighted average data was considered as positive cases irrespective of criteria of diagnosis. Statistical analysis used: Median and inter-quartile range was used. Results: Wide differences in samples and primary outcome variables in these studies were observed. After adjusting for these confounding characteristics, consistent patterns of vitamin A deficiency among Indian preschool-aged children was calculated. The total number of children in this study population was 208379 [with median=1094 and IQR = 283.0 - 8978.0] and the number of children suffering from Vitamin A deficiency disorders was 12510 [with median =80 and IQR = 36.5 - 201.0]. The median prevalence was 7.0% and Inter-Quartile Range (IQR) = 3.3% - 9.3%. Though the study period varied between 1960 and 2005, the median study period was found to be 1999 [with IQR = 1981.5-2004.5]. Conclusion: Wide inter-regional variation in these studies on the prevalence was possibly because of the non-uniform adherence to the diagnostic criteria.

A study of the profile of behavioral risk factors of non communicable diseases in an urban setting using the WHO steps 1 approach

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Anita Nath, Suneela Garg, Sila Deb, Ananya Ray, Ravneet Kaur

India is in the grip of an epidemic posed by non communicable diseases and a rising trend is even being witnessed in low socio-economic urban areas. A total of 531 adults residing in an urban settlement area participated and were interviewed with regard to the presence of behavioral risk factors using the World Health Organization (WHO) STEPS 1 questionnaire on various parameters. Smoking prevalence was found to be 18.4%, out of which more than three-fourths of the adults smoked more than one packet of cigarettes per day. Almost one-third of known hypertensive patients were not on any treatment regimen. A total of 40.3% did not participate in any kind of physical activity; 43% consumed only one serving of green vegetables a day while 58% of the patients included fruits as a part of their diet only once or twice a week. There is a need to develop strong community-based intervention programs that adopt comprehensive preventive and promotive strategies.

Sulfadoxine pyrimethamine was adopted by most African countries based on the recommendation Roll Back Malaria. However, parasite resistant to the drug emerged quicker than Chloroquine resistant and it now becoming an alarming issue in Africa where the malaria burden is high. Although there are lot of studies on sulfadoxine pyrimethamine resistance (SPR), including the identification of the genes responsible for SPR, many question remained unanswered. In this mini review, recent advances of the mechanism of SPR and its impact on health in Africa is highlighted with emphasise on the role of mutation in SPR. It is no doubt that better understanding of SPR will eventually lead to more effective malaria control measures.

We report a very uncommon case of isolated inguinal tubercular lymphadenopathy in a 35-year-old lady with no other pulmonary or extra pulmonary tubercular infection. She responded very well to antitubercular treatment following histological confirmation.

Scleroderma is a group of rare and complex diseases with varied clinical manifestations. The most obvious manifestation of the diseases is skin hardening and sclerosis. A 39-year-old woman presented with complaints of swelling of bilateral lower limbs. The patient also complained of spotty pigmentation of chest, back, and forearm. The patient gave history of weakness of left leg since 3 months. Antinuclear antibody (ANA), anticentromere, and antiDs DNA antibodies were negative. Clinical manifestations were unusual, as the patient had only edema and skin rashes. Visceral organ involvement was only in the form of abnormal liver function test especially lactate dehydrogenase (LDH). The patient also had grossly elevated creatine phosphokinase (CPK) suggesting muscle involvement, though symptom of muscle weakness was only mild. The patient was negative for antinuclear as well as anticentromere antibodies. Diagnosis in this patient was mainly based on skin biopsy findings.

A rare case of genital myiasis in a woman with genital prolapse and malignancy and review of the literature

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Jahar Baidya

Myiasis is a parasitic infestation caused by the larvae of several species. The infestations reduce host physiological functions; destroy host tissues, and causes significant economical losses. It is very rare disease in USA and Europe, seen rarely in tropical and subtropical countries in persons with poor personal hygiene. Diagnosis and treatment are simple. The location of this infestation at genital region is, however, an extremely rare occurrence. The authors present here one case of genital myiasis affecting a village woman with genital prolapse and advanced vaginal malignancy.